It’s Happened Before….
In the factual 1995 feature film Apollo 13 starring Tom Hanks as Jim Lovell, one of the other two Apollo 13 astronauts, Fred Haise played by Bill Paxton, gets quite ill during the flight back from the moon.
Lovell and the third astronaut Jack Swigert struggle to keep Haise alive until rescued at splashdown in the South Pacific. Overlayed on this drama is an accident that destroyed a portion of their spacecraft on the way to the moon, scuttling their planned lunar landing, and instead involving much of NASA to figure out how to keep the astronauts alive.
As it was later diagnosed, Haise had developed a urinary tract infection. The reduced water intake probably caused this infection, but microgravity and the effects of cosmic radiation might have impaired his immune system’s reaction to the pathogen.
Haise’s illness is the most serious recorded medical incident during the Apollo Program (other than the disastrous Apollo One fire), and as far as we know, during the Space Shuttle and International Space Shuttle (ISS) Programs as well. Still, it is very conceivable, and even probable that a future astronaut could become seriously ill in space.
Apollo 13, compared to today’s missions, was of relatively short duration. But what challenges await if an astronaut should become ill in space on a much longer and distant mission, like Mars?
Mini Medical Lab in Space
How might NASA deal with an outbreak in space?
NASA has instituted numerous initiatives to keep the astronauts healthy prior to and during their flights. Yet, the possibility of a medical illness remains.
Thus, the purpose of one of the investigations onboard ISS Crew Resupply Mission-26 in November 2022 is called Moon Microscope. It tests a kit for in-flight medical diagnosis that includes a portable hand-held microscope and a small self-contained blood sample staining device. An astronaut collects and stains a blood sample, obtains images with the microscope, and transmits images to the ground, where flight surgeons use them to diagnose illness and prescribe treatment.
“We do not have a profound clinical problem on the space station, but crew members do experience changes in their immune systems,” says NASA immunologist and principal investigator Brian Crucian. “During deep space missions, all stressors increase and our ability to care for the crew is reduced, a combination that could increase certain clinical risks. This project is designed to create a diagnostic laboratory capability that is highly miniaturized and compatible with microgravity and operational constraints. An ill crew member could perform the blood smear, imaging, and transmission of images in minutes.”
The kit could provide diagnostic capabilities for crew members who become ill in space or on the surface of the Moon or Mars, as well as the ability to test water, food, and surfaces for contamination. The hardware also may enable improved medical monitoring on upcoming Artemis and Gateway missions.
Stocking the Ships of The Future
When aerospace engineers design a new vehicle intended for long-duration space travel, they will need to include a good-sized medicine cabinet. Stocking it, however, is more of a challenge than a quick run to the pharmacy, according to results published from the Stability of Pharmacotherapeutic and Nutritional Compounds, or Stability investigation. This study, which explored pharmaceutical stability on the International Space Station, shows that many medications deteriorate faster in space.
Data from past shuttle missions prompted the investigation, after researchers found certain medications packed aboard the orbiter degraded more rapidly than on Earth. To pinpoint the cause of deterioration, the study had to look at everything from packaging to the physical and chemical characteristics of specific medicines. Principal Investigator Lakshmi Putcha, Ph.D., comments on the multitude of conditions specific to space missions that may be responsible for product breakdown.
“Unique environmental factors include, but are not limited to, ambient radiation, excessive vibrational forces, multiple gravity environments, and carbon dioxide enrichment; this is in addition to unconventional packaging, resupply operations, and other unknowns,” said Putcha.
Space Meds Can Become Dangerous Over Time
The U.S. Food and Drug Administration, or FDA, regulates the safety of medications for human consumption. The Stability study showed, however, that FDA standards may be compromised for medications during space travel. “If pharmaceuticals degrade into chemicals that we do not know the concentration and chemical characteristics to set toxicity limits for,” commented Putcha, “then medications could become not only less effective but even dangerous.”
Researchers studied 35 different medications, including solids, liquids, and capsules. The variety of the selected pharmaceuticals reflected the potential need for crew members to address everything from headaches to fevers. Putcha emphasizes the varied medical concerns long-duration spaceflight may encounter.
“In the future, we will need to pack long-acting antibiotics, as well as bone, muscle, and immune function-enhancing drugs. This is in addition to radiation protectants, cardiovascular medications, anti-anxiety and anti-depressants, fatigue-reducing and performance-enhancing medications, and drugs for emergency medicine, to list some of the ones needed for the space station and beyond,” said Putcha.
The medicines, which were contained in identical stability kits, were launched to the space station aboard STS-121 in July 2006 and remained in orbit for different durations. The first kit returned with the landing of the STS-121 mission, followed by the second, third and fourth kits in June 2007, Feb. 2008 and Nov. 2008, respectively. The samples that were exposed to the space environment were examined after return to Earth for physical and chemical characteristics to check their level of degradation against ground-based control samples.
A higher percentage of medications from each flight kit degraded compared to those in ground control kits.
NASA
Of the antibiotic medications studied, Augmentin was the most unstable due to one of its ingredients: clavulanate. The degradation of clavulanate in space caused the drug to lose almost 50% potency. This was much sooner than the manufacturer’s expiration date on the label. Comparatively, the investigation showed that the antibiotic imipenem/cilastatin — flown in original commercial packaging — remained relatively stable in flight and on the ground.
Part of the challenge with medications in space involves packaging. Due to stowage requirements, some products are taken out of their original manufacturer’s container and repacked for flight. This can increase the susceptibility of the drug to the spacecraft’s ambient environmental conditions and decrease the anticipated shelf life. Results show that 18 of the 33 medications, even from ground control kits, were unstable before projected expiration dates, most likely due to repackaging.
Current Medication Restocking Plan
Currently, aboard the space station, medications are replaced six months prior to their labeled expiration date. For long-duration space exploration, however, such frequent resupply is not possible. Researchers recommend the development of more stable formulations and robust packaging based on the results of this study. The investigation also helped to identify some medications that are stable and maintained their shelf-life in space. Selecting pharmaceuticals with sustained stability implies potential cost savings and more reliable products for crew consumption.
Here on Earth, the results of the Stability investigation can advance the knowledge of environmental effects on food and drugs for remote site medicine and inhabitants of extreme locations, like the Antarctic. The data can also contribute to the development of mathematical models to predict medication shelf life in adverse environments, such as low Earth orbit and beyond. In addition, this research could aid in the development of improved packaging and shielding materials, as well as more stable pharmaceutical formulations.
